Organization
MODERN FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIGAR AFTAB DDS (OWNER)
(484) 686-3723
Entity
Organization
Contact information
Practice address
1131 S 19TH ST, PHILADELPHIA, PA 19146-2936
(215) 546-0388
Mailing address
1131 S 19TH ST, PHILADELPHIA, PA 19146-2936
(215) 546-0388
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS020595L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005290510001
—
PA
05
—
102595694001
—
PA
Enumeration date
11/14/2014
Last updated
11/14/2014
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